Mali Healing Spa

Client Intake Form

Client Name*

Phone Number*

Email*

How did you hear about us?*

Are you pregnant?*

Yes No

Are you currently receiving medical care for any physical injuries, or have you recently undergone surgery that we should be aware of to ensure your comfort and safety during the massage session?*

Yes No

Please describe*

Informed Consent

Signature*

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Date*

Time*

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Please hand the iPad to your therapist so she can review your form.

Review Client Form

For the therapist before the session

Admin

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Informed Consent

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